FEC Form 1 for NCR CORPORATION POLITICAL ACTION COMMITTEE (NCRPAC)Form 1 for NCR CORPORATION POLITICAL ACTION COMMITTEE (NCRPAC)

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-308101

1. NCR CORPORATION POLITICAL ACTION COMMITTEE (NCRPAC)

1401 Noth Taft Street
# 206
Arlington, VA 22201

NOTE: Address is different than previously reported

Email: Elise.Kirban@ncr.com

2. Date: 10/17/2007

3. FEC Committee ID #: C00324103 This committee is a Separate Segregated Fund

Affiliated Committees/Organizations

Committee ID# C00324103
NCR Corporation
1700 South Patterson Blvd.
Dayton, Ohio 45479
Relationship: Connected Organization
Organization Type: Corporation

Custodian of Records:

Patricia Toker
1401 North Taft St.
#206
Arlington, VA 22201
Title: PAC Manager
Phone # (703) 967-0520

Treasurer:

Tim Heffernan
139 Paddington Circle
Smithtown, New York 11787
Title: Treasurer
Phone # (516) 810-0453

Designated Agent(s):

Banks or Depositories

JPMorgan Chase
100 East Broad Street
Floor 11
Columbus, Ohio 43215

Signed: Tim Heffernan
Date Signed: 10/17/2007

(End FEC FORM 1)

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